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Washio Y, Erasmus-Claassen LA, Taylor SN, Zhang Z, Browne FA, Myers B, Wechsberg WM, Parry CDH, Petersen Williams P. An incentive-based text-messaging intervention to reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings from a single-arm pilot study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 38884353 DOI: 10.1111/acer.15392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND South Africa has the highest rate of fetal alcohol spectrum disorders (FASD) globally. As with alcohol use during pregnancy, alcohol consumption while breastfeeding adversely impacts infant development. We pilot tested an incentive-based text-messaging intervention to reduce alcohol use during pregnancy and lactation in South Africa. METHODS A single-arm pilot trial was conducted over 3 months in healthcare facilities in Cape Town, South Africa. Pregnant and breastfeeding participants tested positive for recent alcohol use by urinalysis. The three-month intervention had two components, contingency management of alcohol abstinence confirmed by urinalysis twice weekly and weekly health-related text messaging from an evidence-based brief intervention. We collected twice weekly urine samples for measurement of ethyl glucuronide (EtG), an alcohol biomarker, and measures of self-reported alcohol and drug use, violence exposure, and mental health at six weeks and three months post-enrollment. RESULTS Sixty participants were enrolled, of whom 31 were pregnant and 29 lactating. The number of days with four or more drinks in the past month decreased from 9 days at baseline, on average, to 1-3 days (p-value range: 0.144-0.010) at follow-up timepoints. There were statistically significant increases in the proportions of participants with alcohol-negative urine tests (p < 0.001). The percentages of participants breastfeeding while using alcohol decreased from baseline to the end of 3 months in the overall sample and among those enrolled postpartum, though these were not significant (p-value range: 0.255-0.147). Maternal depression scores also decreased among participants enrolled postpartum (p = 0.054). Emotional abuse by the main partner, but neither physical nor sexual abuse, significantly decreased at both follow-ups in the overall sample (p = 0.032) and among participants enrolled while pregnant (p = 0.015). CONCLUSIONS This study is among the first to pilot test an incentive-based text-messaging intervention for maternal alcohol use and other outcomes such as depression and violence exposure. Further testing is warranted in a well-powered, randomized controlled trial.
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Affiliation(s)
- Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lesley-Ann Erasmus-Claassen
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Shantae N Taylor
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Zugui Zhang
- Christiana Care Health System, Institute for Research on Equity and Community Health, Newark, Delaware, USA
| | - Felicia A Browne
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Wendee M Wechsberg
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Charles D H Parry
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Petal Petersen Williams
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Dionisi T, Di Sario G, De Mori L, Spagnolo G, Antonelli M, Tarli C, Sestito L, Mancarella FA, Ferrarese D, Mirijello A, Vassallo GA, Gasbarrini A, Addolorato G. Current treatments of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:127-152. [PMID: 38555114 DOI: 10.1016/bs.irn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Emerging treatments for alcohol dependence reveal an intricate interplay of neurobiological, psychological, and circumstantial factors that contribute to Alcohol Use Disorder (AUD). The approved strategies balancing these factors involve extensive manipulations of neurotransmitter systems such as GABA, Glutamate, Dopamine, Serotonin, and Acetylcholine. Innovative developments are engaging mechanisms such as GABA reuptake inhibition and allosteric modulation. Closer scrutiny is placed on the role of Glutamate in chronic alcohol consumption, with treatments like NMDA receptor antagonists and antiglutamatergic medications showing significant promise. Complementing these neurobiological approaches is the progressive shift towards Personalized Medicine. This strategy emphasizes unique genetic, epigenetic and physiological factors, employing pharmacogenomic principles to optimize treatment response. Concurrently, psychological therapies have become an integral part of the treatment landscape, tackling the cognitive-behavioral dimension of addiction. In instances of AUD comorbidity with other psychiatric disorders, Personalized Medicine becomes pivotal, ensuring treatment and prognosis are closely defined by individual characteristics, as exemplified by Lesch Typology models. Given the high global prevalence and wide distribution of AUD, a persistent necessity exists for development and improvement of treatments. Current research efforts are steadily paving paths towards more sophisticated, effective typology-based treatments: a testament to the recognized imperative for enhanced treatment strategies. The potential encapsulated within the ongoing research suggests a promising future where the clinical relevance of current strategies is not just maintained but significantly improved to effectively counter alcohol dependence.
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Affiliation(s)
- Tommaso Dionisi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Giovanna Di Sario
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Lorenzo De Mori
- Department of Neuroscience, Section of Psychiatry, Catholic University of Rome, Rome, Italy
| | - Giorgia Spagnolo
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Mariangela Antonelli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Tarli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Sestito
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Antonio Mancarella
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele Ferrarese
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Antonio Mirijello
- Unit of Internal Medicine, IRCCS "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | | | - Antonio Gasbarrini
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy.
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Jett JD, Beck R, Tyutyunnyk D, Sanchez J, Weeks DL, Javors MA, Hill-Kapturczak N, Lopez-Cruzan M, Kriegel L, Ginsburg BC, Cabassa L, McDonell MG. Feasibility of a telehealth-based contingency management intervention for alcohol use disorders using the phosphatidylethanol (PEth) 16:0/18:1 alcohol biomarker: a pilot randomized trial. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:162-172. [PMID: 38284925 DOI: 10.1080/00952990.2023.2283691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/11/2023] [Indexed: 01/30/2024]
Abstract
Background: Phosphatidylethanol (PEth) is a blood-based biomarker for alcohol consumption that can be self-collected and has high sensitivity, specificity, and a longer detection window compared to other alcohol biomarkers.Objectives: We evaluated the feasibility and acceptability of a telehealth-based contingency management (CM) intervention for alcohol use disorder (AUD) using the blood-based biomarker PEth to assess alcohol consumption.Methods: Sixteen adults (7 female, 9 male) with AUD were randomized to Control or CM conditions. Control participants received reinforcers regardless of their PEth levels. CM participants received reinforcers for week-to-week decreases in PEth (Phase 1) or maintenance of PEth consistent with abstinence (<20 ng/mL, Phase 2). Blood samples were self-collected using the TASSO-M20 device. Acceptability was assessed by retention in weeks. Satisfaction was assessed with the Client Satisfaction Questionnaire (CSQ-8) and qualitative interviews. The primary efficacy outcome was PEth-defined abstinence. Secondary outcomes included the proportion of visits with PEth-defined heavy alcohol consumption, negative urine ethyl glucuronide results, and self-reported alcohol use.Results: Retention averaged 18.6 ± 8.8 weeks for CM participants. CM participants reported high levels of satisfaction (CSQ-8, Mean = 30.3 ± 1.5). Interview themes included intervention positives, such as staff support, quality of life improvement, and accountability. 72% of PEth samples from CM participants were consistent with abstinence versus 34% for Control participants (OR = 5.0, p = 0.007). PEth-defined heavy alcohol consumption was detected in 28% of CM samples and 52% of Control samples (OR = 0.36, p = 0.159). CM participants averaged 1.9 ± 1.7 drinks/day versus 4.2 ± 6.3 for Control participants (p = 0.304).Conclusion: Results support the acceptability and satisfaction of a telehealth PEth-based CM intervention, though a larger study is needed to assess its efficacy [NCT04038021].
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Affiliation(s)
- Julianne D Jett
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachael Beck
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Diana Tyutyunnyk
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Jesus Sanchez
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Douglas L Weeks
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Martin A Javors
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Marisa Lopez-Cruzan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Liat Kriegel
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Brett C Ginsburg
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Leopoldo Cabassa
- Brown School, Washington University St. Louis, St Louis, MO, USA
| | - Michael G McDonell
- PRISM Collaborative, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Hallihan H, Abboud S, Lee S, Rospenda K, Srimoragot M, Fink A, Ma J. A qualitative exploration of young adults' perceptions of a new intervention for alcohol use disorder. Ann Med 2024; 55:2295983. [PMID: 38175792 PMCID: PMC10769559 DOI: 10.1080/07853890.2023.2295983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Due to the rising prevalence of alcohol use disorders among young adults, the need for effective and accessible interventions has become increasingly imperative. In acknowledgment of this issue, we developed a novel intervention known as contingency management plus problem solving therapy (CM-PST). The aim of the current study was to gain insight into the perspectives on the effectiveness of the newly developed CM-PST using focus group discussion among young adults who consume alcohol regularly. MATERIALS AND METHODS The study employed a qualitative research design, utilizing focus group discussions as the primary data collection method. Participants described their perceptions regarding the newly developed CM-PST. Semi-structured focus group sessions were conducted via Zoom in November 2022. A total of 19 young adults, aged 18-24 years old, participated in five focus group sessions. Data were analyzed using deductive content analysis. RESULTS Participants demonstrated overall positive attitudes toward the novel intervention, recognizing the potential benefits, it could offer in terms of alcohol use reduction and emotional well-being. They emphasized the importance of incentives in motivating behavioral changes, as well as the practicality of problem-solving techniques in addressing everyday challenges. Additionally, participants provided valuable insights into potential barriers and implementation challenges, highlighting the need for flexible and personalized approaches to accommodate individual preferences and needs. CONCLUSIONS The results of this study contribute to the growing body of literature on innovative intervention approaches for young adults facing alcohol use issues. The findings shed light on the acceptability and perceived effectiveness of the CM-PST intervention from the perspective of the target population.
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Affiliation(s)
- Hagar Hallihan
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Sangeun Lee
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Kathleen Rospenda
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | | | - Anne Fink
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Dougherty DM, Moon TJ, Liang Y, Roache JD, Lamb RJ, Mathias CW, Wasserman AM, Wood EE, Hill-Kapturczak N. Effectiveness of contingency management using transdermal alcohol monitoring to reduce heavy drinking among driving while intoxicated (DWI) arrestees: A randomized controlled trial. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1989-2001. [PMID: 37864527 DOI: 10.1111/acer.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Driving while intoxicated (DWI) is a serious public health problem. However, treatment for DWI arrestees is not readily available. This study examines the effectiveness of a contingency management (CM) procedure using transdermal alcohol concentration (TAC) monitoring to reduce drinking among DWI arrestees. METHOD The study participants were 216 DWI arrestees under pretrial and included both Mandated participants undergoing court-ordered TAC monitoring and Non-Mandated participants wearing a study-provided TAC monitor. Participants were randomly assigned to either a CM (Mandated = 35; Non-Mandated = 74) or a Control condition (Mandated = 37; Non-Mandated = 70) and completed the 8-week intervention. CM participants received $50/week for not exceeding a TAC of 0.02 g/dL during the previous week. Payments to Controls were yoked to the CM group. RESULTS Among Non-Mandated participants, the probability of meeting the contingency was higher and remained stable (about 65%) over time in the CM group, whereas the probability was lower and declined in the Control group, widening the gaps in the probability between the study conditions (16.7%-24.1% greater in the CM group from visit 4 to 8, all p < 0.05). Among Mandated participants, the probability was not significantly different between conditions (p = 0.06-0.95). Furthermore, among Non-Mandated participants, the percentage of heavy drinking days remained low (9.16%-11.37%) in the CM group, whereas it was greater and increased over time (17.43%-26.59%) in the Control group. In Mandated participants, no significant differences in percent heavy drinking days were observed between conditions (p = 0.07-0.10). CONCLUSION We found that contingency effects on alcohol use are more pronounced among frequent and heavy alcohol users, i.e., Non-Mandated DWI arrestees. However, for individuals whose drinking was already suppressed by existing contingencies (i.e., court-mandated TAC monitoring), our CM procedure did not produce additional reductions in drinking.
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Affiliation(s)
| | - Tae-Joon Moon
- Department of Health, Behavior, and Society, University of Texas School of Public Health San Antonio, San Antonio, Texas, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard J Lamb
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Charles W Mathias
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Erin E Wood
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Xu J, Yan X, Figueroa C, Williams JJ, Chakraborty B. A flexible micro-randomized trial design and sample size considerations. Stat Methods Med Res 2023; 32:1766-1783. [PMID: 37491804 DOI: 10.1177/09622802231188513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Technological advancements have made it possible to deliver mobile health interventions to individuals. A novel framework that has emerged from such advancements is the just-in-time adaptive intervention, which aims to suggest the right support to the individuals when their needs arise. The micro-randomized trial design has been proposed recently to test the proximal effects of the components of these just-in-time adaptive interventions. However, the extant micro-randomized trial framework only considers components with a fixed number of categories added at the beginning of the study. We propose a more flexible micro-randomized trial design which allows addition of more categories to the components during the study. Note that the number and timing of the categories added during the study need to be fixed initially. The proposed design is motivated by collaboration on the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation study, which learns to deliver effective text messages to encourage physical activity among patients with diabetes and depression. We developed a new test statistic and the corresponding sample size calculator for the flexible micro-randomized trial using an approach similar to the generalized estimating equation for longitudinal data. Simulation studies were conducted to evaluate the sample size calculators and an R shiny application for the calculators was developed.
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Affiliation(s)
- Jing Xu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Xiaoxi Yan
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Caroline Figueroa
- Faculty of Technology, Policy and Management, Delft University of Technology, The Netherlands
- School of Social Welfare, University of California, Berkeley, USA
| | - Joseph Jay Williams
- Department of Computer Science, University of Toronto, ON, Canada
- Department of Statistical Sciences, University of Toronto, ON, Canada
- Department of Psychology, University of Toronto, ON, Canada
- Vector Institute for Artificial Intelligence Faculty Affiliate, University of Toronto, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, ON, Canada
- Department of Economics, University of Toronto, ON, Canada
| | - Bibhas Chakraborty
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
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Coughlin LN, Salino S, Jennings C, Lacek M, Townsend W, Koffarnus MN, Bonar EE. A systematic review of remotely delivered contingency management treatment for substance use. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208977. [PMID: 36804352 PMCID: PMC10936237 DOI: 10.1016/j.josat.2023.208977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/23/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Substance use and related consequences (e.g., impaired driving, injuries, disease transmission) continue to be major public health concerns. Contingency management (CM) is a highly effective treatment for substance use disorders. Yet CM remains vastly underutilized, in large part due to implementation barriers to in-person delivery. If feasible and effective, remote delivery of CM may reduce barriers at both the clinic- and patient-level, thus increasing reach and access to effective care. Here, we summarize data from a systematic review of studies reporting remote delivery of CM for substance use treatment. METHODS We conducted a systematic review, reported according to PRISMA guidelines. The study team identified a total of 4358 articles after deduplication. Following title and abstract screening, full-text screening, and reference tracking, 39 studies met the eligibility criteria. We evaluated the methodological quality of the included studies using the Effective Public Health Practice Project Quality tool. RESULTS Of 39 articles included in the review, most (n = 26) targeted cigarette smoking, with others focusing on alcohol (n = 9) or other substance use or targeting multiple substances (n = 4). Most remotely delivered CM studies focused on abstinence (n = 29), with others targeting substance use reduction (n = 2), intervention engagement (n = 5), and both abstinence and intervention engagement (n = 3). CM was associated with better outcomes (either abstinence, use reduction, or engagement), with increasingly more remotely delivered CM studies published in more recent years. Studies ranged from moderate to strong quality, with the majority (57.5 %) of studies being strong quality. CONCLUSIONS Consistent with in-person CM, remotely delivered CM focusing on abstinence or use reduction from substances or engagement in substance use treatment services improves outcomes at the end of treatment compared to control conditions. Moreover, remotely delivered CM is feasible across a variety of digital delivery platforms (e.g., web, mobile, and wearable), with acceptability and reduced clinic and patient burden as technological advancements streamline monitoring and reinforcer delivery.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Sarah Salino
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Claudia Jennings
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Madelyn Lacek
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mikhail N Koffarnus
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI 48109, USA
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Miguel AQ, Smith CL, Rodin NM, Johnson RK, McDonell MG, McPherson SM. Automated Reinforcement Management System: Feasibility study findings of an app-based contingency management treatment for alcohol use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100140. [PMID: 36994367 PMCID: PMC10040325 DOI: 10.1016/j.dadr.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
Alcohol Use Disorder (AUD) is the most prevalent substance use disorder in the United States and is directly related to 5% of all annually reported deaths worldwide. Contingency Management (CM) is among the most effective interventions for AUD, with recent technological advancements allowing CM to be provided remotely. Objective: To evaluate the feasibility and acceptability of a mobile Automated Reinforcement Management System (ARMS) designed to provide CM for AUD remotely. Methods: Twelve participants with mild or moderate AUD were exposed to ARMS in a A-B-A within-subject experimental design where they were required to submit three breathalyzer samples per day. During the B phase participants could earned rewards with monetary value for submitting negative samples. Feasibility was determined by the proportion of samples submitted and retention in the study and acceptability was based on participants self-reported experience. Results: The mean number of samples submitted per day was 2.02 out of 3. The proportion of samples submitted in each phase was 81.5%, 69.4% and 49.4%, respectively. Participants were retained for a mean of 7.5 (SD=1.1) out of 8 weeks with 10 participants (83.3%) completing the study. All participants found the app easy to use and stated it helped them reduce their alcohol use. Eleven (91.7%) would recommend the app as an adjunct to AUD treatment. Preliminary indicators of efficacy are also presented. Conclusions: ARMS has shown to be feasible and well accepted. If shown effective, ARMS can serve as an adjunctive treatment for AUD.
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Affiliation(s)
- André Q. Miguel
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
- Corresponding author.
| | - Crystal L. Smith
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
| | - Nicole M. Rodin
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
| | | | - Michael G. McDonell
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
| | - Sterling M. McPherson
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Analytics and PsychoPharmacology Laboratory, Spokane, WA, United States
- Program of Excellence in Addictions Research, Spokane, WA, United States
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Reisfield GM, Teitelbaum SA, Jones JT, Mason D, Bleiweis M, Lewis B. Blood Phosphatidylethanol (PEth) Concentrations following Intensive Use of an Alcohol-based Hand Sanitizer. J Anal Toxicol 2023; 46:979-990. [PMID: 34748012 DOI: 10.1093/jat/bkab115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 01/26/2023] Open
Abstract
Alcohol use disorders are prevalent in the USA and throughout the world. Monitoring for alcohol abstinence is useful in several clinical and forensic contexts. The direct alcohol biomarkers have the requisite sensitivity and specificity for abstinence monitoring. The relatively new direct biomarker phosphatidylethanol (PEth), measured in blood, is gaining increasing acceptance in monitoring abstinence from beverage alcohol consumption, but there remains little research addressing the potential for PEth formation consequent to incidental alcohol exposures. In the midst of the coronavirus disease 2019 pandemic, high-alcohol content hand sanitizer is a particularly important source of nonbeverage alcohol exposure. To assess the extent of alcohol absorption and subsequent formation of blood PEth related to intensive use of high alcohol content hand sanitizer, we recruited 15 participants to use a 70% ethyl alcohol-based hand sanitizer 24-100 times daily, for 12-13 consecutive days. Blood was analyzed for PEth 16:0/18:1 by liquid chromatography--tandem mass spectrometry. Our hypothesis that blood PEth concentrations would fail to reach a 20 ng/mL threshold was confirmed. This work adds to the nascent literature on the effects of incidental alcohol exposures on blood PEth formation.
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Affiliation(s)
- Gary M Reisfield
- UF Health Springhill, University of Florida College of Medicine, 4037 NW 86th Terrace, Gainesville, FL 32606, USA
| | - Scott A Teitelbaum
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
| | - Joseph T Jones
- United States Drug Testing Laboratories, Inc., 1700 S Mount Prospect Road, Des Plaines, IL 60018, USA
| | - Dana Mason
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
| | - Max Bleiweis
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
| | - Ben Lewis
- University of Florida College of Medicine, 1600 Sw Archer Road, Gainesville, FL 32610, USA
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10
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Athamneh LN, Brown J, Stein JS, Gatchalian KM, LaConte SM, Bickel WK. Future thinking to decrease real-world drinking in alcohol use disorder: Repairing reinforcer pathology in a randomized proof-of-concept trial. Exp Clin Psychopharmacol 2022; 30:326-337. [PMID: 35041442 PMCID: PMC9450688 DOI: 10.1037/pha0000460] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reinforcer Pathology theory proposes that expanding the temporal window of reinforcement (i.e., reducing delay discounting) using episodic future thinking (EFT) would decrease alcohol consumption. However, evidence of effectiveness in real-world settings is lacking. Using a randomized proof-of-concept field trial, the current study examined the effect of expanding the temporal window of reinforcement, using remotely delivered EFT, on decreasing real-world alcohol consumption among individuals with alcohol use disorder (AUD). Fifty-two individuals (9 females) aged 18-65 years who met the DSM-5 criteria for moderate or severe AUD and aimed to drink in moderation or abstain from drinking completed the study and were included in analysis. EFT significantly (p = .031) reduced alcohol consumption (mean change of consumption pre-post intervention = -2.18 drinks/day) compared to control episodic recent thinking (ERT; mean change of -0.52 drinks/day). Changes in discounting rates pre-post intervention significantly predicted changes in alcohol consumption (coef. = .424, 95% CI [.043-.813], p = .030) even after controlling for age, gender, race, income, education, marital status, and family history of addiction. Overall satisfaction across groups was rated as 3.92 on a 1 to 5-point scale, suggesting that the current remote approach is feasible and acceptable. The current findings were congruent with the theory, Reinforcer Pathology, that EFT expands the temporal window and decreases alcohol consumption, and the remote approach was considered feasible and acceptable. We believe the present study contributes new knowledge with tangible benefits for scientifically understanding and better defining novel interventions that may be clinically deployed to improve treatment outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Liqa N. Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA
| | - Jeremiah Brown
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA
| | - Jeffrey S. Stein
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA
| | - Kirstin M. Gatchalian
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA
| | | | - Warren K. Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at Virginia Tech Carilion, VA, USA
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11
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Smith CL, Rodin NM, Hwang JY, Miguel AQC, Johnson K, McDonell MG, McPherson SM. Automated Reinforcement Management System (ARMS): focused phase I provider feedback. Addict Sci Clin Pract 2022; 17:20. [PMID: 35346358 PMCID: PMC8962143 DOI: 10.1186/s13722-022-00301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Alcohol use increases risk for morbidity and mortality and is associated with over 3 million annual deaths worldwide. Contingency Management (CM) is one of the most effective interventions for substance use disorders, and has recently been coupled with technologies to promote novel treatments for alcohol use disorders (AUD). Leveraging these technological advances, we are developing the Automated Reinforcement Management System (ARMS), an integrated CM system designed to enable CM treatment as a component of a digital therapeutic or adjunct therapy remotely to anyone with a smartphone. Objective To collect detailed provider feedback on ARMS and determine the need for modifications to make the system most feasible, acceptable, and useful to providers. Methods Seven providers completed one-hour structured interviews/focus groups wherein we described the ARMS system and its application to clinical care. Providers viewed screen shots of the ARMS provider facing and patient facing systems. Providers gave feedback on their current AUD treatment practices, preferences for the functionality and appearance of the system, preferences for receipt of information on their patients, why they and their patients would or would not use the system, suggestions for improvement, and the proposed intervention overall. To analyze the qualitative data gathered, we used a qualitative descriptive approach with content analysis methods. Results The overarching theme of Individualized Treatment emerged throughout the interviews. This sentiment supports use of ARMS, as it is intended to supplement provider communication and intervention as an adjunctive and customizable tool with the ability to reach rural patients, not a stand-alone option. Themes of Accountability and Objective Assessment arose during discussions of why people would use the system. Themes within provider obstacles included, Information Overload and Clinical Relevance, and in patient obstacles, Sustained Engagement and Security Concerns. Two themes emerged regarding suggestions for improvement: Increasing Accessibility and Bi-directional Communication. Discussion Themes from provider input are being used to modify ARMS to make it more user friendly, time saving, and relevant to treatment of AUD. If successful, ARMS will provide effective, individualized-digital therapeutic for those needing adjunctive treatment or those living in rural remote areas needing better connected care.
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Affiliation(s)
- Crystal L Smith
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA. .,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA. .,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA.
| | - Nicole M Rodin
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Julie Y Hwang
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA
| | - André Q C Miguel
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA
| | - Kim Johnson
- Managed Health Connections, Spokane, WA, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA.,Behavioral Health Innovations, Washington State University, Spokane, WA, USA
| | - Sterling M McPherson
- Elson S. Floyd College of Medicine, Washington State University, PO Box 1495, Spokane, WA, 99210-1495, USA.,Analytics and PsychoPharmacology Laboratory (APPL), Spokane, WA, USA.,Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, USA
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12
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Buono FD, Gleed C, Boldin M, Aviles A, Wheeler N. Preliminary Effectiveness of a Remotely Monitored Blood Alcohol Concentration Device as Treatment Modality: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e30186. [PMID: 35029534 PMCID: PMC8800086 DOI: 10.2196/30186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background Alcohol use disorder is a chronic disorder with a high likelihood of relapse. The consistent monitoring of blood alcohol concentration through breathalyzers is critical to identifying relapse or misuse. Smartphone apps as a replacement of or in conjunction with breathalyzers have shown limited effectiveness. Yet, there has been little research that has effectively utilized wireless or Wi-Fi–enabled breathalyzers that can accurately, securely, and reliably measure blood alcohol concentration. Objective The purpose of this study is to evaluate the impact of a wireless blood alcohol concentration device in collaboration with long-term treatment on dropout rates, psychological distress, treatment motivation, quality of life, and need for higher levels of follow-up care for patients with alcohol use disorder. Methods The randomized clinical trial will include two arms, access to the wireless breathalyzer versus no access to the breathalyzer, while both groups have access to treatment. Evaluation will last 3 months with a 6-week follow-up, during which each participant will be interviewed at admission, 1 month in, 2 months in, 3 months in, and follow-up. Individuals will be recruited online through a secure telehealth meeting invitation. Outcomes will focus on the impact of the wireless breathalyzer within the alcohol use disorder population, and the combined effect on psychological distress, treatment motivation, and quality of life. In addition, we intend to investigate the impact of the breathalyzer on dropout rates and participants’ need for higher levels of follow-up care and treatment. Results The recruitment of this study started in July 2020 and will run until 2022. Conclusions This information will be important to develop cost-effective treatments for alcohol dependence. Ongoing monitoring allows treatment providers to take an individualized disease management approach and facilitates timely intervention by the treatment provider. Trial Registration ClinicalTrials.gov NCT04380116; http://clinicaltrials.gov/ct2/show/NCT04380116 International Registered Report Identifier (IRRID) DERR1-10.2196/30186
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Affiliation(s)
- Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Colette Gleed
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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13
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Silva KDS, Sampaio AAS, Miguel ADQC. Contingency Management applied to Alcohol Use Disorder: Systematic Review. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38215.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This systematic review evaluated the efficacy of applying Contingency Management (CM) to Alcohol Use Disorder. We followed the PRISMA recommendation and consulted the following databases: Cochrane Library, MEDLINE Complete, PsycINFO and Pubmed. A total of eight randomized controlled trials were included in this review, all of them with good methodological quality. In seven of these, CM was more efficacious in promoting continuous abstinence. Both trials that evaluated treatment retention found statistically significant results favorable to CM. On two of the three trials presenting follow-up results, CM was more efficacious in promoting abstinence. The large-scale application of CM can promote substantial public health improvements and should be encouraged.
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14
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Silva KDS, Sampaio AAS, Miguel ADQC. Manejo de Contingência Aplicado ao Transtorno por Uso de Álcool: Revisão Sistemática. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38215.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Resumo Esta revisão sistemática avaliou a eficácia do Manejo de Contingência (MC) no tratamento do Transtorno por Uso de Álcool. Para isso, foi utilizada a recomendação PRISMA e consultadas as bases de dados: Cochrane Library, MEDLINE Complete, PsycINFO e Pubmed. Foram incluídos oito ensaios clínicos randomizados nesta revisão. Em sete, o MC foi mais eficaz em promover abstinência continuada. Dos dois que avaliaram a retenção no tratamento, ambos encontraram resultados estatisticamente favoráveis ao MC. Dos três que apresentaram resultados de avaliação de seguimento, em dois o MC foi mais eficaz em promover abstinência. Todos apresentaram boa qualidade metodológica. A aplicação do MC em larga escala pode promover melhorias substanciais para a saúde pública e deve ser encorajada.
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15
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Zetterström A, Hämäläinen MD, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. The Clinical Course of Alcohol Use Disorder Depicted by Digital Biomarkers. Front Digit Health 2021; 3:732049. [PMID: 34950928 PMCID: PMC8688853 DOI: 10.3389/fdgth.2021.732049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: This study introduces new digital biomarkers to be used as precise, objective tools to measure and describe the clinical course of patients with alcohol use disorder (AUD).Methods: An algorithm is outlined for the calculation of a new digital biomarker, the recovery and exacerbation index (REI), which describes the current trend in a patient's clinical course of AUD. A threshold applied to the REI identifies the starting point and the length of an exacerbation event (EE). The disease patterns and periodicity are described by the number, length, and distance between EEs. The algorithms were tested on data from patients from previous clinical trials (n = 51) and clinical practice (n = 1,717).Results: Our study indicates that the digital biomarker-based description of the clinical course of AUD might be superior to the traditional self-reported relapse/remission concept and conventional biomarkers due to higher data quality (alcohol measured) and time resolution. We found that EEs and the REI introduce distinct tools to identify qualitative and quantitative differences in drinking patterns (drinks per drinking day, phosphatidyl ethanol levels, weekday and holiday patterns) and effect of treatment time.Conclusions: This study indicates that the disease state—level, trend and periodicity—can be mathematically described and visualized with digital biomarkers, thereby improving knowledge about the clinical course of AUD and enabling clinical decision-making and adaptive care. The algorithms provide a basis for machine-learning-driven research that might also be applied for other disorders where daily data are available from digital health systems.
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Affiliation(s)
| | | | | | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- Fred Nyberg
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16
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Holtyn AF, Toegel F, Novak MD, Leoutsakos JM, Fingerhood M, Silverman K. Remotely delivered incentives to promote buprenorphine treatment engagement in out-of-treatment adults with opioid use disorder. Drug Alcohol Depend 2021; 225:108786. [PMID: 34087746 PMCID: PMC8282759 DOI: 10.1016/j.drugalcdep.2021.108786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opioid overdose remains a leading cause of death. Office-based buprenorphine could expand access to treatment to the many opioid users who are not in treatment and who are at risk for opioid overdose. However, many people in need of buprenorphine treatment do not enroll in treatment. This randomized pilot trial evaluated efficacy of a remotely delivered incentive intervention in promoting engagement in buprenorphine treatment in out-of-treatment adults with opioid use disorder. METHODS Participants (N = 41) were offered referrals to buprenorphine treatment and randomly assigned to Control or Incentive groups for 6 months. Incentive participants were offered incentives for enrolling in buprenorphine treatment, verified by providing documentation showing that they received a buprenorphine prescription, and providing videos taking daily buprenorphine doses. Participants used a smartphone application to record and submit a video of their buprenorphine prescription and daily buprenorphine administration. Incentive earnings were added remotely to reloadable credit cards. RESULTS Incentive participants were significantly more likely to enroll in treatment compared to control participants (71.4 % versus 30.0 % of participants; OR [95 % CI]: 6.24 [1.46-26.72], p = .014). Few participants in either group adhered to buprenorphine treatment, and the two groups continued to use opioids, including fentanyl at high and comparable rates. The two groups did not differ in the percentage of urine samples that were positive for buprenorphine, opiates, fentanyl, or methadone at monthly assessments conducted during the 6-month intervention. CONCLUSIONS Remotely delivered incentives can connect out-of-treatment adults with opioid use disorder to treatment, but additional supports are needed to promote buprenorphine adherence.
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Affiliation(s)
- August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Miguel A, Smith C, Perea N, Johnson K, McDonell M, McPherson S. Development of Automated Reinforcement Management System (ARMS): Protocol for a Phase I Feasibility and Usability Study. JMIR Form Res 2021; 5:e25796. [PMID: 34279238 PMCID: PMC8329757 DOI: 10.2196/25796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/12/2021] [Accepted: 05/31/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alcohol use is directly related to over 3 million deaths worldwide every year. Contingency management is a cost-effective treatment for substance use disorders; however, few studies have examined its efficacy for alcohol use disorder. Recent technological advances have enabled the combined use of mobile apps and low-cost electronic breathalyzer devices to remotely monitor alcohol use. Leveraging this type of technology, our study group has recently developed an integrated contingency management system that would enable community treatment programs to remotely deliver contingency management to anyone who owns a smartphone. OBJECTIVE In this paper, we present a full description of our integrated contingency management system, Automated Reinforcement Management System (ARMS), and describe a protocol that will evaluate its feasibility and usability. METHODS Initially, 6 clinicians will participate in a 1-hour focus group where the study staff will navigate through ARMS as it would be used by clinicians and patients. Clinicians will provide feedback on the intervention in general, which will be used to modify ARMS to make it more user friendly, time saving, and relevant to treatment. A second focus group will summarize the changes made following the initial clinician feedback and will provide additional input regarding the potential utilization of ARMS. Thereafter, the clinicians' acceptability of ARMS will be evaluated using the System Usability Scale. Following the clinicians' assessments of ARMS and final modifications, the system will be evaluated in terms of feasibility and patient usability by using an A-B-A within-subject experimental design wherein 20 treatment-seeking individuals with alcohol use disorder will be recruited. The two A phases (control conditions) will each last 2 weeks, and the B phase (contingency management condition) will last 4 weeks. During all phases, participants will be asked to use the ARMS app to submit three breathalyzer samples per day (at 10 AM, 2 PM, and 8 PM). Participants will be prompted by the ARMS app at these predetermined times to record and submit their breathalyzer samples. During the A phases, participants will earn vouchers for every breathalyzer sample submitted, independent of their sample results. During the B phase, vouchers will be provided contingent upon the submission of alcohol-negative breathalyzer samples (breath alcohol content = 0.00). At the end of the A-B-A experiment trial, patients' usability of the ARMS app will be evaluated using the System Usability Scale. Feasibility will be measured based on whether the ARMS app helped significantly increase alcohol abstinence. RESULTS Recruitment for this study began in January 2021 and is expected to be completed by December 2021. CONCLUSIONS This study will provide the baseline capability for the implementation of a remotely monitored contingency management platform. If successful, ARMS has the potential to provide effective treatment for alcohol use disorders to individuals living in remote rural areas.
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Affiliation(s)
- Andre Miguel
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Crystal Smith
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Nicole Perea
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | - Kim Johnson
- Managed Health Connections, Spokane, WA, United States
| | - Michael McDonell
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Sterling McPherson
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
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18
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Hammond AS, Sweeney MM, Chikosi TU, Stitzer ML. Digital delivery of a contingency management intervention for substance use disorder: A feasibility study with DynamiCare Health. J Subst Abuse Treat 2021; 126:108425. [PMID: 34116816 PMCID: PMC8197772 DOI: 10.1016/j.jsat.2021.108425] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Digital health tools can provide convenient delivery of evidence-based treatments. The DynamiCare Health smartphone app delivers a contingency management intervention for substance use disorder consisting of remote self-testing for alcohol (breath) and drugs (saliva) with remote test validation and delivery of financial incentives for negative test results. This study examined feasibility, engagement (duration and consistency of app utilization), and impact on usual care treatment participation when a community substance use treatment program implemented this digital therapy among its patients. The study randomly assigned patients with alcohol use disorder (N = 61) to receive either DynamiCare along with treatment-as-usual (TAU; N = 29) or TAU only (N = 32) during a 90-day evaluation period. Mean duration between first and last app use was 64 (±35) days, with mean earnings of $248 (±$209, out of $600 maximum). Among those with any app use (n = 25), compliance was 68% and 74%, respectively for requested breath and saliva samples. Overall, two thirds of patients (66%) assigned to the app used it for at least 57 days and with high rates of self-testing compliance. Those completing the assessment (n = 13; 45% of sample) endorsed high satisfaction ratings. DynamiCare versus TAU participants were more likely to be retained in usual care treatment at 90 days (24% vs 3%; (χ2 (1, 61) = 5.9, p < 0.05), but sustained app utilization was associated with a wide range of usual care treatment participation. These data suggest that DynamiCare Health is feasible and potentially beneficial as a complement to community substance use treatment programs.
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Affiliation(s)
| | | | | | - Maxine L Stitzer
- Johns Hopkins University School of Medicine, USA; Friends Research Institute, USA
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19
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Pilot Study of an Integrated Smartphone and Breathalyzer Contingency Management Intervention for Alcohol Use. J Addict Med 2021; 14:193-198. [PMID: 31567597 DOI: 10.1097/adm.0000000000000553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Monitoring devices provide a platform for assessing alcohol use and implementing alcohol interventions. This pilot study focused on assessing the early-stage feasibility and usability of a smartphone-based application and breathalyzer used in a contingency management intervention for alcohol use. METHODS Six nontreatment-seeking participants completed a 9-week ABA within-subjects designed intervention targeting alcohol use. Participants submitted 2 to 8 alcohol breathalyzer samples per day and completed self-report drinking measures and usability assessments. During the A phases (weeks 1-3 and 8-9), participants received reinforces for submitting breathalyzer samples, regardless of their results. During the contingency management, B phase (weeks 4-7), and received reinforcers only when negative breathalyzer samples were submitted. Usability assessment of the application was also conducted during weeks 2 and 9. RESULTS Participants in the contingent B phase (49%) were more likely to submit alcohol-negative breathalyzer samples compared with the noncontingent A phases (27%; P < 0.001). Usability assessment of the application varied, and participants noted several technical concerns. CONCLUSION The use of smartphones and breathalyzers may be a practical solution to extend the reach of contingency management during and after treatment.
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Delgado MK, Shofer F, Wetherill R, Curtis B, Hemmons J, Spencer E, Branas C, Wiebe DJ, Kranzler HR. Accuracy of Consumer-marketed smartphone-paired alcohol breath testing devices: A laboratory validation study. Alcohol Clin Exp Res 2021; 45:1091-1099. [PMID: 33966283 DOI: 10.1111/acer.14597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although alcohol breath testing devices that pair with smartphones are promoted for the prevention of alcohol-impaired driving, their accuracy has not been established. METHODS In a within-subjects laboratory study, we administered weight-based doses of ethanol to two groups of 10 healthy, moderate drinkers aiming to achieve a target peak blood alcohol concentration (BAC) of 0.10%. We obtained a peak phlebotomy BAC and measured breath alcohol concentration (BrAC) with a police-grade device (Intoxilyzer 240) and two randomly ordered series of 3 consumer smartphone-paired devices (6 total devices) with measurements every 20 min until the BrAC reached <0.02% on the police device. Ten participants tested the first 3 devices, and the other 10 participants tested the other 3 devices. We measured mean paired differences in BrAC with 95% confidence intervals between the police-grade device and consumer devices. RESULTS The enrolled sample (N = 20) included 11 females; 15 white, 3 Asian, and 2 Black participants; with a mean age of 27 and mean BMI of 24.6. Peak BACs ranged from 0.06-0.14%. All 7 devices underestimated BAC by >0.01%, though the BACtrack Mobile Pro and police-grade device were consistently more accurate than the Drinkmate and Evoc. Compared with the police-grade device measurements, the BACtrack Mobile Pro readings were consistently higher, the BACtrack Vio and Alcohoot measurements similar, and the Floome, Drinkmake, and Evoc consistently lower. The BACtrack Mobile Pro and Alcohoot were most sensitive in detecting BAC driving limit thresholds, while the Drinkmate and Evoc devices failed to detect BAC limit thresholds more than 50% of the time relative to the police-grade device. CONCLUSIONS The accuracy of smartphone-paired devices varied widely in this laboratory study of healthy participants. Although some devices are suitable for clinical and research purposes, others underestimated BAC, creating the potential to mislead intoxicated users into thinking that they are fit to drive.
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Affiliation(s)
- Mucio Kit Delgado
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Frances Shofer
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Reagan Wetherill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Curtis
- Technology and Translational Research Unit, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Jessica Hemmons
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Evan Spencer
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles Branas
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Crescenz VA Medical Center, Philadelphia, PA, USA
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21
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Systematic review on use of health incentives in U.S. to change maternal health behavior. Prev Med 2021; 145:106442. [PMID: 33515587 PMCID: PMC7956068 DOI: 10.1016/j.ypmed.2021.106442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 12/22/2020] [Accepted: 01/24/2021] [Indexed: 11/20/2022]
Abstract
Use of financial incentives contingent on health outcomes has shown effective in health behavior change. Evidence-based information on the effect of incentive use for maternal health behavior change can inform whether and how to proceed with future research as well as incorporate incentive-based interventions in the existing healthcare system. This systematic literature review was conducted among prospective studies on incentive use for maternal health behavior change in a U.S. cohort according to the PRISMA methodology. Databases subject to the search included PubMed, Web of Science, PsycINFO, and EBSCOhost. Studies published in peer-reviewed journals on or before January 7, 2019, written in English, conducted in U.S., using incentives contingent on maternal health behavior change, and prospectively designed were included. Two authors independently searched titles and abstracts. An abstraction table was constructed, and the risk of bias was assessed using the GRADE approach. The review showed that incentives such as vouchers and other financial incentives were effective in improving outcomes especially related to substance use, tobacco use, and breastfeeding. Mixed evidence was found in improving treatment adherence outcomes; however the studies with randomized trials on the outcome of treatment adherence also showed low certainty. Continued improvements need to be made in implementing an incentive-based approach in the context of comprehensive treatment and routine healthcare, exploring electronic- or mobile-based implementation of the approach, and implementing the approach for a wider variety of outcomes during both prenatal and postpartum periods.
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22
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Hämäläinen MD, Zetterström A, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. Breathalyser-Based eHealth Data Suggest That Self-Reporting of Abstinence Is a Poor Outcome Measure for Alcohol Use Disorder Clinical Trials. Alcohol Alcohol 2021; 55:237-245. [PMID: 32118260 DOI: 10.1093/alcalc/agaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the efficacy and monitoring capabilities of a breathalyser-based eHealth system for patients with alcohol use disorder (AUD) and to investigate the quality and validity of timeline follow-back (TLFB) as outcome measure in clinical trials and treatment. METHODS Patients (n = 115) were recruited to clinical trials from a 12-step aftercare programme (12S-ABS) and from hospital care with abstinence (HC-ABS) or controlled drinking (HC-CDR) as goal and randomly divided into an eHealth and a control group. The effect of the eHealth system was analysed with TLFB-derived primary outcomes-change in number of abstinent days (AbsDay) and heavy drinking days (HDDs) compared to baseline-and phosphatidyl ethanol (PEth) measurements. Validity and quality of TLFB were evaluated by comparison with breath alcohol content (BrAC) and eHealth digital biomarkers (DBs): Addiction Monitoring Index (AMI) and Maximum Time Between Tests (MTBT). TLFB reports were compared to eHealth data regarding reported abstinence. RESULTS The primary outcome (TLFB) showed no significant difference between eHealth and control groups, but PEth did show a significant difference especially at months 2 and 3. Self-reported daily abstinence suffered from severe quality issues: of the 28-day TLFB reports showing full abstinence eHealth data falsified 34% (BrAC measurements), 39% (MTBT), 54% (AMI) and 68% (BrAC/MTBT/AMI). 12S-ABS and HC-ABS patients showed severe under-reporting. CONCLUSIONS No effect of the eHealth system was measured with TLFB, but a small positive effect was measured with PEth. The eHealth system revealed severe quality problems with TLFB, especially regarding abstinence-should measurement-based eHealth data replace TLFB as outcome measure for AUD?
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Affiliation(s)
| | | | - Maria Winkvist
- Kontigo Care AB, Påvel Snickares Gränd 12, 753 20 Uppsala, Sweden
| | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Dag Hammarskjölds väg 14 B, Uppsala Science Park, 751 83 Uppsala, Sweden
| | - Karl Andersson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, 751 85 Uppsala, Sweden.,Ridgeview Instruments AB, Skillsta 4, 740 20 Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 751 24 Uppsala, Sweden
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23
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DeFulio A, Rzeszutek MJ, Furgeson J, Ryan S, Rezania S. A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program. J Subst Abuse Treat 2021; 120:108188. [DOI: 10.1016/j.jsat.2020.108188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
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24
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Dallery J, Stinson L, Bolívar H, Modave F, Salloum RG, Viramontes TM, Rohilla P. mMotiv8
: A smartphone‐based contingency management intervention to promote smoking cessation. J Appl Behav Anal 2020; 54:38-53. [DOI: 10.1002/jaba.800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - François Modave
- Department of Health Outcomes & Biomedical Informatics University of Florida
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics University of Florida
| | | | - Pulkit Rohilla
- Department of Health Outcomes & Biomedical Informatics University of Florida
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25
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Validation of transdermal alcohol concentration data collected using wearable alcohol monitors: A systematic review and meta-analysis. Drug Alcohol Depend 2020; 216:108304. [PMID: 33007701 DOI: 10.1016/j.drugalcdep.2020.108304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of transdermal alcohol content (TAC) data (i.e. index test) collected with wearable alcohol monitors for assessment of alcohol use or any other alcohol related outcome (e.g., excessive alcohol use) among adults 18 and older. METHODS We will systematically search MEDLINE, EMBASE, PsycINFO, and the Social Sciences Citation Index (SSCI, Web of Science) for TAC validation studies. The reference standards for this systematic review study are alcohol use data collected through self-reports, breathalyzers, or blood samples. If enough studies are available to conduct a meta-analysis, we will use a hierarchical regression approach to pool the results and obtain summary point estimates.
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26
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Hswen Y, Qin Q, Williams DR, Viswanath K, Subramanian SV, Brownstein JS. Online negative sentiment towards Mexicans and Hispanics and impact on mental well-being: A time-series analysis of social media data during the 2016 United States presidential election. Heliyon 2020; 6:e04910. [PMID: 33005781 PMCID: PMC7519357 DOI: 10.1016/j.heliyon.2020.e04910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/18/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose was to use Twitter to conduct online surveillance of negative sentiment towards Mexicans and Hispanics during the 2016 United States presidential election, and to examine its relationship with mental well-being in this targeted group at the population level. Methods Tweets containing the terms Mexican(s) and Hispanic(s) were collected within a 20-week period of the 2016 United States presidential election (November 9th 2016). Sentiment analysis was used to capture percent negative tweets. A time series lag regression model was used to examine the association between percent count of negative tweets mentioning Mexicans and Hispanics and percent count of worry among Hispanic Gallup poll respondents. Results Of 2,809,641 tweets containing terms Mexican(s) and Hispanic(s), 687,291 tweets were negative. Among 8,314 Hispanic Gallup respondents, a mean of 33.5% responded to be worried on a daily basis. A significant lead time of 1 week was observed, showing that negative tweets mentioning Mexicans and Hispanics appeared to forecast daily worry among Hispanics by 1 week. Conclusion Surveillance of online negative sentiment towards racially vulnerable population groups can be captured using social media. This has potential to identify early warning signals for symptoms of mental well-being among targeted groups at the population level.
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Affiliation(s)
- Yulin Hswen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Computational Epidemiology Lab, Harvard Medical School, Boston, MA, USA.,Innovation Program, Boston Children's Hospital, Boston, MA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.,Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, USA
| | - Qiuyuan Qin
- Innovation Program, Boston Children's Hospital, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of African and African American Studies, Harvard University, Cambridge, MA, USA
| | - K Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - John S Brownstein
- Computational Epidemiology Lab, Harvard Medical School, Boston, MA, USA.,Innovation Program, Boston Children's Hospital, Boston, MA, USA
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27
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Getty C, Morande A, Lynskey M, Weaver T, Metrebian N. Mobile telephone-delivered contingency management interventions promoting behaviour change in individuals with substance use disorders: a meta-analysis. Addiction 2019; 114:1915-1925. [PMID: 31265747 PMCID: PMC6852192 DOI: 10.1111/add.14725] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 06/20/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS Contingency management (CM) interventions have gained considerable interest due to their success in the treatment of addiction. However, their implementation can be resource-intensive for clinical staff. Mobile telephone-based systems might offer a low-cost alternative. This approach could facilitate remote monitoring of behaviour and delivery of the reinforcer and minimize issues of staffing and resources. This systematic review and meta-analysis assessed the evidence for the effectiveness of mobile telephone-delivered CM interventions to promote abstinence (from drugs, alcohol and tobacco), medication adherence and treatment engagement among individuals with substance use disorders. DESIGN A systematic search of databases (PsychINFO, CINAHL, MEDLINE PubMed, CENTRAL, Embase) for randomized controlled trials and within-subject design studies (1995-2019). The review was conducted in accordance with the PRISMA statement. The protocol was registered on PROSPERO. SETTING All included studies originated in the United states. PARTICIPANTS Seven studies were found, including 222 participants; two targeted alcohol abstinence among frequent drinkers and four targeted smoking cessation (in homeless veterans and those with post-traumatic stress disorder). One targeted medication adherence. MEASURES The efficacy of CM to increase alcohol and nicotine abstinence was compared with control using several outcomes; percentage of negative samples (PNS), quit rate (QR) and longest duration abstinent (LDA) at the end of the intervention. FINDINGS The random-effects meta-analyses produced pooled effect sizes of; PNS [d = 0.94, 95% confidence interval (CI) = 0.63-1.25], LDA (d = 1.08, 95% CI = 0.69-1.46) and QR (d = 0.46, 95% CI = 0.27-0.66), demonstrating better outcomes across the CM conditions. Most of the studies were rated as of moderate quality. 'Fail-safe N' computations for PNS indicated that 50 studies would be needed to produce a non-significant overall effect size. None could be calculated for QR and LDA due to insufficient number of studies. CONCLUSION Mobile telephone-delivered contingency management performs significantly better than control conditions in reducing tobacco and alcohol use among adults not in treatment for substance use disorders.
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Affiliation(s)
- Carol‐Ann Getty
- King's College LondonThe National Addiction CentreLondonUK
- Department of Mental Health and Social WorkMiddlesex UniversityLondonUK
| | - Ana Morande
- King's College LondonThe National Addiction CentreLondonUK
- Department of Mental Health and Social WorkMiddlesex UniversityLondonUK
| | - Michael Lynskey
- King's College LondonThe National Addiction CentreLondonUK
- Department of Mental Health and Social WorkMiddlesex UniversityLondonUK
| | - Tim Weaver
- King's College LondonThe National Addiction CentreLondonUK
- Department of Mental Health and Social WorkMiddlesex UniversityLondonUK
| | - Nicola Metrebian
- King's College LondonThe National Addiction CentreLondonUK
- Department of Mental Health and Social WorkMiddlesex UniversityLondonUK
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28
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Dallery J, Raiff BR, Grabinski MJ, Marsch LA. Technology-Based Contingency Management in the Treatment of Substance-Use Disorders. Perspect Behav Sci 2019; 42:445-464. [PMID: 31976444 PMCID: PMC6768925 DOI: 10.1007/s40614-019-00214-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Contingency management is one of the most efficacious interventions to promote drug abstinence. Contingency management has traditionally been delivered in person so that clinicians could confirm drug abstinence and provide access to additional therapeutic services. Now, new technologies not only permit remote confirmation of abstinence, but also remote delivery of incentives. We discuss several technology-based tools to assess substance use, and new ways to deliver contingency management to promote tobacco, alcohol, and cannabis abstinence. These new tools have the potential to dramatically increase access while maintaining high levels of treatment fidelity. Technology-based methods also allow arranging group contingencies that harness online communities, and they permit targeting multiple health-risk behaviors with a combination of sensor-based technologies. Overall, there are unprecedented opportunities to link technology with contingency management to promote drug abstinence.
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Affiliation(s)
- Jesse Dallery
- Department of Psychology, University of Florida, PO Box 112250, Gainesville, FL 32611 USA
| | | | | | - Lisa A. Marsch
- The Geisel School of Medicine, Dartmouth College, Hanover, NH USA
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29
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Rash CJ, Alessi SM, Zajac K. Examining implementation of contingency management in real-world settings. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:89-98. [PMID: 31343197 DOI: 10.1037/adb0000496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Very little is known about how reward programs are implemented in real-world substance use treatment settings and whether training in contingency management (CM), an empirically supported rewards-based intervention, impacts their design quality. Providers (N = 214) completed surveys assessing CM beliefs, training, and practices related to use of tangible rewards in treatment. For providers reporting they had not used rewards in treatment previously (54%, n = 116), we assessed beliefs about and interest in adopting a reward-based program. For those endorsing prior reward experience (46%, n = 98), we assessed the features and delivery of rewards and the relation of reward-based intervention training to 4 parameters related to CM efficacy: reinforcement magnitude, immediacy, frequency, and escalation. Among providers without reward experience, endorsement of supportive statements about CM predicted interest in adopting a rewards-based program. Providers with reward experience most often targeted treatment attendance and engaged in behaviors likely to decrease the effectiveness of the intervention, including use of low magnitudes (≤ $25/client), delayed reinforcement, failure to escalate reward values, and offering reward opportunities less than weekly. Providers with longer durations of training were more likely to engage in behaviors consistent with effective CM, including larger magnitude rewards and immediate delivery of rewards. Results indicate that real-world treatment clinics are using reward-based programs but not in ways consistent with research protocols. Longer training exposure is associated with greater adherence to some aspects of CM protocol design. Other evidence-based design features are not being implemented as recommended, even with training. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carla J Rash
- University of Connecticut Health School of Medicine
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30
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Rash CJ, DePhilippis D. Considerations for Implementing Contingency Management in Substance Abuse Treatment Clinics: The Veterans Affairs Initiative as a Model. Perspect Behav Sci 2019; 42:479-499. [PMID: 31976446 DOI: 10.1007/s40614-019-00204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Contingency management (CM) is an efficacious intervention for the treatment of substance use disorders that is widely applicable across a range of client populations and characteristics. Despite its strong evidence base, CM remains underutilized in real world practice. This article introduces CM for clinicians interested in adopting CM and briefly reviews this research evidence. In addition, CM protocols are described, with emphasis on the specific design considerations important to CM's efficacy. The recent Department of Veterans Affairs (VA) initiative, which represents the first successful large-scale implementation effort, is presented. It provides a model for the training and supervision components that may be critical to implementation with fidelity. Continued research in this area, as well as further demonstrations of successful dissemination and implementation, will be critical for improving the adoption of this intervention in clinical, nonresearch settings.
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Affiliation(s)
- Carla J Rash
- 1Calhoun Cardiology Center, University of Connecticut Health School of Medicine, 263 Farmington, Avenue (MC 3944), Farmington, CT 06030-3944 USA
| | - Dominick DePhilippis
- 2Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz Veterans Administration Medical Center, Perelman School of Medicine, Department of Veterans Affairs, Pennsylvania, PA USA
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Telehealth Treatment for Alcohol Misuse: Reviewing Telehealth Approaches to Increase Engagement and Reduce Risk of Alcohol-Related Hypertension. Curr Hypertens Rep 2019; 21:59. [DOI: 10.1007/s11906-019-0966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Piasecki TM. Assessment of Alcohol Use in the Natural Environment. Alcohol Clin Exp Res 2019; 43:564-577. [PMID: 30748019 PMCID: PMC6443469 DOI: 10.1111/acer.13975] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/03/2019] [Indexed: 02/02/2023]
Abstract
The current article critically reviews 3 methodological options for assessing drinking episodes in the natural environment. Ecological momentary assessment (EMA) typically involves using mobile devices to collect self-report data from participants in daily life. This technique is now widely used in alcohol research, but investigators have implemented diverse assessment strategies. This article focuses on "high-resolution" EMA protocols that oversample experiences and behaviors within individual drinking episodes. A number of approaches have been used to accomplish this, including using signaled follow-ups tied to drinking initiation, asking participants to log entries before and after individual drinks or drinking episodes, and delivering frequent signaled assessments during periods of the day when alcohol use is most common. Transdermal alcohol sensors (TAS) are devices that are worn continuously and are capable of detecting alcohol eliminated through the skin. These methods are appealing because they do not rely upon drinkers' self-report. Studies using TAS have been appearing with greater frequency over the past several years. New methods are making the use of TAS more tractable by permitting back-translation of transdermal alcohol concentration data to more familiar estimates of blood alcohol concentration or breath alcohol concentration. However, the current generation of devices can have problems with missing data and tend to be relatively insensitive to low-level drinking. An emerging area of research investigates the possibility of using mobile device data and machine learning to passively detect the user's drinking, with promising early findings. EMA, TAS, and sensor-based approaches are all valid, and tend to produce convergent information when used in conjunction with one another. Each has a unique profile of advantages, disadvantages, and threats to validity. Therefore, the nature of the underlying research question must dictate the method(s) investigators select.
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Affiliation(s)
- Thomas M Piasecki
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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33
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Song T, Qian S, Yu P. Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e10899. [PMID: 30694200 PMCID: PMC6371076 DOI: 10.2196/10899] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/02/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear. Objective This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes. Methods We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies. Results In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory. Conclusions Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.
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Affiliation(s)
- Ting Song
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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34
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Abdulrahman SA, Ganasegeran K. m-Health in Public Health Practice. TELEMEDICINE TECHNOLOGIES 2019. [PMCID: PMC7150233 DOI: 10.1016/b978-0-12-816948-3.00011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Beyond the earlier skepticism that greeted its usefulness and applicability in public health practice, m-Health has continued to gain significant support and acceptability among public health practitioners in terms of the ease with which its features and reach have been harnessed to address global disease prevention and health promotion objectives. Research evidence over the past few decades suggest the positive effect of adopting m-Health in improving knowledge dissemination, creating and sustaining motivation for positive health behavior changes or practices, and empowering individuals, communities and populations to take greater responsibility for their health. This chapter examines historical and current literature evidence of m-Health application in public health practice, its impact on global population health and future prospects.
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Gao J, Cao J, Guo T, Xiao Y. Association between alcoholic interventions and abstinence rates for alcohol use disorders: A meta-analysis. Medicine (Baltimore) 2018; 97:e13566. [PMID: 30558020 PMCID: PMC6320082 DOI: 10.1097/md.0000000000013566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of present study is to quantitatively evaluate the association between different interventions and abstinence rates based on network meta-analysis. METHOD Following PRISMA guidelines, randomized clinical trials that compared different alcoholic interventions for alcohol use disorders associated with abstinence rates in treatment sessions or/and follow-up sessions were recruited. Main data synthesis was performed by Bayesian random-effects network meta-analyses, and the relative ranking of interventions was estimated by cumulative probability P values (SUCRA). Funnel plot symmetry was used to detect publication bias. Moreover, pair-wised comparison was also conducted to determine the statistical difference and forest plots were generated to calculate the differences between the groups. The Grades of Recommendations Assessment, Development and Evaluation (GRADE) criteria were utilized for the recommendations of evidence from pairwise direct comparisons. RESULTS A total of 137 RCTs containing 27,282 participants and 8 variations of psychotherapy, pharmacotherapy, contingency management, and brief intervention used as treatment interventions were included. In summary, contingency management plus psychotherapy was demonstrated to be effective and possessed the best rank of achieving the highest abstinence rate in treatment sessions (SUCRA, 0.61). Pharmacotherapy plus psychotherapy also revealed its efficacy and was associated with the highest abstinence rate in follow-up sessions (SUCRA, 0.40). More importantly, psychotherapy alone was demonstrated not to be associated with higher abstinence rates in both treatment (OR, 1.052; 95% CI, 0.907-1.220) and follow-up sessions (OR, 0.967; 95% CI, 0.552-1.693), yet pharmacotherapy seemed to be the only intervention associated with higher abstinence rates compared to controls in both sessions (treatment session: OR, 1.074; 95% CI, 1.002-1.152) (follow-up session: OR, 1.442; 95% CI, 1.094-1.900). CONCLUSIONS Contingency management plus psychotherapy and pharmacotherapy plus psychotherapy were demonstrated to be associated with the highest abstinence rates in treatment sessions and follow-up sessions, respectively. However, contingency management and pharmacotherapy seemed to be the substantial crucial factors allowing for the maintenance of the highest abstinence rates in respective sessions, although we need more evidence for further validation.
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Affiliation(s)
- Jiamin Gao
- Department of Emergency, Huashan Hospital, Fudan University, Shanghai
| | - Jun Cao
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Yunyue Xiao
- Department of Clinical Psychology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Koffarnus MN, Bickel WK, Kablinger AS. Remote Alcohol Monitoring to Facilitate Incentive-Based Treatment for Alcohol Use Disorder: A Randomized Trial. Alcohol Clin Exp Res 2018; 42:2423-2431. [PMID: 30335205 PMCID: PMC6286218 DOI: 10.1111/acer.13891] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/13/2018] [Indexed: 11/29/2022]
Abstract
Background The delivery of monetary incentives contingent on verified abstinence is an effective treatment for alcohol use disorder. However, technological barriers to accurate, frequent biochemical verification of alcohol abstinence have limited the dissemination of this technique. Methods In the present randomized parallel trial, we employed a breathalyzer that allows remote, user‐verified collection of a breath alcohol sample, text messaging, and reloadable debit cards for remote delivery of incentives to evaluate a contingency management treatment for alcohol use disorder that can be delivered with no in‐person contact. Treatment‐seeking participants with alcohol use disorder (n = 40) were recruited from the community and randomized to either a contingent or a noncontingent group (n = 20 each). The contingent group received nearly immediate monetary incentives each day they remotely provided negative breathalyzer samples. The noncontingent group received matched monetary payments each day they successfully provided samples independent of alcohol content. Groups were not masked as awareness of group contingencies was an essential intervention component. Results The primary outcome of the intent‐to‐treat analyses (analyzed n = 40) was percent days abstinent as measured by the remote breathalyzer samples. Abstinence rates in the contingent group were 85%, which was significantly higher than the 38% recorded in the noncontingent group, corresponding to an odds ratio of 9.4 (95% CI = 4.0 to 22.2). Breathalyzer collection adherence rates were over 95%, and participant ratings of acceptability were also high. Conclusions These results support the efficacy, acceptability, and feasibility of this remotely deliverable abstinence reinforcement incentive intervention for the initiation and near‐term maintenance of abstinence from alcohol in adults with alcohol use disorder. Due to low provider and participant burden, this procedure has the potential for broad dissemination.
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Affiliation(s)
| | - Warren K Bickel
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, Virginia
| | - Anita S Kablinger
- Psychiatry and Behavioral Sciences, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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Watkins LE, Sprang K. An Overview of Internet- and Smartphone-Delivered Interventions for Alcohol and Substance Use Disorders. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:376-383. [PMID: 31975929 DOI: 10.1176/appi.focus.20180016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Substance use disorders are a serious public health concern that affect approximately one in 12 individuals 12 years and older. Despite the high need for effective treatments for substance use disorders, the underutilization of services is well documented. One potential method of increasing access to care is through the use of technology. Treatment through the Internet or smartphone provides attractive solutions for those who are ambivalent to seeking treatment, because these treatments are easy to access from almost anywhere, self-paced, low commitment, and anonymous. The purpose of this review is to summarize the literature on Internet and smartphone interventions for substance use disorders that were developed on the basis of evidence-based treatments. The authors discuss these interventions within two broad categories: brief motivational or feedback-oriented interventions, which typically include one or two sessions, and longer interventions, which include multiple modules and are based on cognitive-behavior therapy, relapse prevention, contingency management, or a community reinforcement approach. These therapeutic adaptations through new technologies allow for increased access to substance use treatments and appear to yield overall positive results in adjusting norms about substance use, decreasing and ceasing substance use, and improving confidence to manage substance use.
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Affiliation(s)
- Laura E Watkins
- Dr. Watkins and Dr. Sprang are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
| | - Kelsey Sprang
- Dr. Watkins and Dr. Sprang are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
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Monk RL, Qureshi AW, McNeill A, Erskine-Shaw M, Heim D. Perfect for a Gin and Tonic: How Context Drives Consumption Within a Modified Bogus Taste Test. Alcohol Alcohol 2018; 53:228-234. [PMID: 29136090 DOI: 10.1093/alcalc/agx084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/04/2017] [Indexed: 11/13/2022] Open
Abstract
Aim To implement a modified bogus taste test (BTT) and to examine the interactive effects of environmental and social contexts on levels of 'alcohol' consumption. Method University students (Study 1 n = 38, Study 2 n = 80), recruited via opportunity sampling, completed a modified BTT under the pretence of assessing garnish preference for gin and tonic. All participants were tested alone or as part of an existing friendship group. In Study 1 participants were in a laboratory setting but were exposed to different contextual cues (alcohol-related or neutral) by way of posters displayed on the walls. In Study 2, participants assessed the drinks in either a pub or a library setting. Results In Study 1 participants tested in a group consumed significantly more when exposed to pub-related stimuli in contrast to those who were exposed to library-related stimuli. Participants who were alone and exposed to library-related cues consumed significantly more than those in a group and exposed to these cues. In Study 2, as in Study 1, participants tested in a group condition consumed significantly more of what they believed to be alcohol when in the pub compared to those who were tested in the library. Higher group consumption was also evident in the library condition, although the size of this difference was not as large as in the pub testing condition. Conclusion In the absence of any pharmacological effects of alcohol, social and environmental context have an interactive impact on shaping consumption.
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Affiliation(s)
- Rebecca L Monk
- Department of Psychology, Edge Hill University, St Helens Rd, Ormskirk L39 4QP, UK
| | - Adam W Qureshi
- Department of Psychology, Edge Hill University, St Helens Rd, Ormskirk L39 4QP, UK
| | - Adam McNeill
- Department of Psychology, Edge Hill University, St Helens Rd, Ormskirk L39 4QP, UK
| | | | - Derek Heim
- Department of Psychology, Edge Hill University, St Helens Rd, Ormskirk L39 4QP, UK
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McPherson SM, Burduli E, Smith CL, Herron J, Oluwoye O, Hirchak K, Orr MF, McDonell MG, Roll JM. A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Subst Abuse Rehabil 2018; 9:43-57. [PMID: 30147392 PMCID: PMC6095117 DOI: 10.2147/sar.s138439] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This review of contingency management (CM; the behavior-modification method of providing reinforcement in exchange for objective evidence of a desired behavior) for the treatment of substance-use disorders (SUDs) begins by describing the origins of CM and how it has come to be most commonly used during the treatment of SUDs. Our core objective is to review, describe, and discuss three ongoing critical advancements in CM. We review key emerging areas wherein CM will likely have an impact. In total, we qualitatively reviewed 31 studies in a systematic fashion after searching PubMed and Google Scholar. We then describe and highlight CM investigations across three broad themes: adapting CM for underserved populations, CM with experimental technologies, and optimizing CM for personalized interventions. Technological innovations that allow for mobile delivery of reinforcers in exchange for objective evidence of a desired behavior will likely expand the possible applications of CM throughout the SUD-treatment domain and into therapeutically related areas (eg, serious mental illness). When this mobile technology is coupled with new, easy-to-utilize biomarkers, the adaptation for individual goal setting and delivery of CM-based SUD treatment in hard-to-reach places (eg, rural locations) can have a sustained impact on communities most affected by these disorders. In conclusion, there is still much to be done, not only technologically but also in convincing policy makers to adopt this well-established, cost-effective, and evidence-based method of behavior modification.
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Affiliation(s)
- Sterling M McPherson
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Ekaterina Burduli
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - Crystal Lederhos Smith
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Jalene Herron
- Programs of Excellence in Addictions Research, Washington State University,
- Behavioral Health Interventions (BHI), Washington State University, Spokane, WA, USA
| | - Oladunni Oluwoye
- Programs of Excellence in Addictions Research, Washington State University,
- Behavioral Health Interventions (BHI), Washington State University, Spokane, WA, USA
| | - Katherine Hirchak
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Michael F Orr
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - Michael G McDonell
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - John M Roll
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
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Bagot KS, Matthews SA, Mason M, Squeglia LM, Fowler J, Gray K, Herting M, May A, Colrain I, Godino J, Tapert S, Brown S, Patrick K. Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health. Dev Cogn Neurosci 2018; 32:121-129. [PMID: 29636283 PMCID: PMC6447367 DOI: 10.1016/j.dcn.2018.03.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 01/06/2023] Open
Abstract
Mobile and wearable technologies and novel methods of data collection are innovating health-related research. These technologies and methods allow for multi-system level capture of data across environmental, physiological, behavioral, and psychological domains. In the Adolescent Brain Cognitive Development (ABCD) Study, there is great potential for harnessing the acceptability, accessibility, and functionality of mobile and social technologies for in-vivo data capture to precisely measure factors, and interactions between factors, that contribute to childhood and adolescent neurodevelopment and psychosocial and health outcomes. Here we discuss advances in mobile and wearable technologies and methods of analysis of geospatial, ecologic, social network and behavioral data. Incorporating these technologies into the ABCD study will allow for interdisciplinary research on the effects of place, social interactions, environment, and substance use on health and developmental outcomes in children and adolescents.
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Affiliation(s)
- K S Bagot
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S A Matthews
- Penn State University, 507 Oswald Tower, University Park, PA, 16802, USA.
| | - M Mason
- University of Tennessee, Henson Hall, 213 Knoxville, Knoxville, TN, 37996-3332, USA.
| | - Lindsay M Squeglia
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - J Fowler
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Gray
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - M Herting
- University of Southern California, 2011 N Soto St., Los Angeles, CA, 90032, USA.
| | - A May
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - I Colrain
- SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA.
| | - J Godino
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Tapert
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Brown
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Patrick
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
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Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research. Addict Behav 2018; 83:5-17. [PMID: 29174666 DOI: 10.1016/j.addbeh.2017.11.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023]
Abstract
Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.
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Maternal Behavioral Health: Fertile Ground for Behavior Analysis. Perspect Behav Sci 2018; 41:637-652. [PMID: 31976417 DOI: 10.1007/s40614-018-0143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The World Health Organization has identified four behavioral health priorities as risk factors for noncommunicable diseases in maternal populations: tobacco use, harmful alcohol use, poor nutrition, and lack of physical activity. These risk factors also significantly affect pregnant and immediately postpartum mothers, doubling the health risk and economic burden by adversely affecting maternal and birth or infant outcomes. Psychosocial and behavioral interventions are ideal for pregnant and immediately postpartum women as opposed to pharmacotherapy. Among other behavioral interventions, the use of incentives based on the principles of reinforcement has been a successful yet controversial way to change health behaviors. Implementing an incentive-based intervention in maternal health often brings up social validity concerns. The existing guideline on how to develop and conduct research in incentive-based interventions for maternal health lacks enough information on the specific variables to control for to maintain the intervention's effectiveness. This article outlines some of the critical variables in implementing an effective behavior-analytic intervention and addressing social validity concerns to change maternal behaviors in a sustainable manner, along with specific research topics needed in the field to prevent adverse maternal, birth, and infant outcomes.
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Hämäläinen MD, Zetterström A, Winkvist M, Söderquist M, Karlberg E, Öhagen P, Andersson K, Nyberg F. Real-time Monitoring using a breathalyzer-based eHealth system can identify lapse/relapse patterns in alcohol use disorder Patients. Alcohol Alcohol 2018; 53:368-375. [DOI: 10.1093/alcalc/agy011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/09/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Elin Karlberg
- Innovation Akademiska, Akademiska Sjukhuset, Uppsala, Sweden
| | - Patrik Öhagen
- Uppsala Clinical Research Center, Dag Hammarskjöldsväg 14 B, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Skillsta 4, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, Uppsala, Sweden
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Gharani P, Suffoletto B, Chung T, Karimi HA. An Artificial Neural Network for Movement Pattern Analysis to Estimate Blood Alcohol Content Level. SENSORS (BASEL, SWITZERLAND) 2017; 17:E2897. [PMID: 29236078 PMCID: PMC5751642 DOI: 10.3390/s17122897] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/02/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
Abstract
Impairments in gait occur after alcohol consumption, and, if detected in real-time, could guide the delivery of "just-in-time" injury prevention interventions. We aimed to identify the salient features of gait that could be used for estimating blood alcohol content (BAC) level in a typical drinking environment. We recruited 10 young adults with a history of heavy drinking to test our research app. During four consecutive Fridays and Saturdays, every hour from 8 p.m. to 12 a.m., they were prompted to use the app to report alcohol consumption and complete a 5-step straight-line walking task, during which 3-axis acceleration and angular velocity data was sampled at a frequency of 100 Hz. BAC for each subject was calculated. From sensor signals, 24 features were calculated using a sliding window technique, including energy, mean, and standard deviation. Using an artificial neural network (ANN), we performed regression analysis to define a model determining association between gait features and BACs. Part (70%) of the data was then used as a training dataset, and the results tested and validated using the rest of the samples. We evaluated different training algorithms for the neural network and the result showed that a Bayesian regularization neural network (BRNN) was the most efficient and accurate. Analyses support the use of the tandem gait task paired with our approach to reliably estimate BAC based on gait features. Results from this work could be useful in designing effective prevention interventions to reduce risky behaviors during periods of alcohol consumption.
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Affiliation(s)
- Pedram Gharani
- Department of Informatics and Networked Systems, University of Pittsburgh School of Computing and Information, Pittsburgh, PA 15260, USA.
| | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Tammy Chung
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Hassan A Karimi
- Department of Informatics and Networked Systems, University of Pittsburgh School of Computing and Information, Pittsburgh, PA 15260, USA.
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Petry NM, Alessi SM, Olmstead TA, Rash CJ, Zajac K. Contingency management treatment for substance use disorders: How far has it come, and where does it need to go? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:897-906. [PMID: 28639812 PMCID: PMC5714694 DOI: 10.1037/adb0000287] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Contingency management (CM) interventions consistently improve substance abuse treatment outcomes, yet CM remains a highly controversial intervention and is rarely implemented in practice settings. This article briefly outlines the evidence base of CM and then describes 4 of the most often-cited concerns about it: philosophical, motivational, durability, and economic. Data supporting and refuting each of these issues are reviewed. The article concludes with suggestions to address these matters and other important areas for CM research and implementation, with the aims of improving uptake of this efficacious intervention in practice settings and outcomes of patients with substance use disorders. (PsycINFO Database Record
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Affiliation(s)
- Nancy M Petry
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Sheila M Alessi
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | | | - Carla J Rash
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Kristyn Zajac
- Calhoun Cardiology Center, University of Connecticut School of Medicine
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Nehlin C, Carlsson K, Öster C. Patients' Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes. J Addict Med 2017; 12:107-112. [PMID: 29176448 DOI: 10.1097/adm.0000000000000373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The field of eHealth systems is rapidly developing and is now expanding into alcohol treatment settings. Despite a growing public and professional interest, cellular photo digital breathalyzers (CPDBs) have not been investigated in a clinical context so far. In this study, we aimed to investigate the experiences of patients in alcohol treatment who had been using a CPDB-TripleA- for a minimum of three months. What are their personal experiences of using the CPDB? Do the patients think it supports them to change their drinking habits, and if so, in what way? METHODS A qualitative interview study with individuals who had been using the CPDB TripleA, for at least 3 months as complement to treatment (12-step program or hospital-based outpatient care). A thematic analysis with an inductive approach was used to identify, analyze, and interpret patterns within data. RESULTS In all, 12 interviews were conducted with 8 men and 4 women. Participants were generally enthusiastic about the CPDB and found it convenient and useful, even though it created a need for privacy when using the device. Although technical problems were substantial, participants were tolerant to those. The system was perceived to support self-control and to restore relations, but did not replace the need for close contact with caregivers. Self-motivation to change drinking habits was essential, and could not be reached by solely using the CPDB. CONCLUSIONS Participants perceived the CPDB as a convenient and useful tool that was supportive under the circumstances that it was used in a context that included personal contact with a caregiver; and the user felt more than just a minimum of motivation to reduce drinking. Technical stability needs to be achieved to secure long-term use.
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Affiliation(s)
- Christina Nehlin
- Uppsala University, Department of Neuroscience, Psychiatry and Uppsala University Hospital, Psychiatric Department, Sweden
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Alessi SM, Rash CJ, Petry NM. A Randomized Trial of Adjunct mHealth Abstinence Reinforcement With Transdermal Nicotine and Counseling for Smoking Cessation. Nicotine Tob Res 2017; 19:290-298. [PMID: 27613901 DOI: 10.1093/ntr/ntw155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/02/2016] [Indexed: 12/16/2022]
Abstract
Introduction Abstinence reinforcement is efficacious for improving smoking treatment outcomes, but practical constraints related to the need for multiple in-person carbon monoxide (CO) breath tests daily to verify smoking abstinence have limited its use. This study tested an mHealth procedure to remotely monitor and reinforce smoking abstinence in individuals' natural environment. Methods Eligible treatment-seeking smokers (N = 90) were randomized to (1) usual care and ecological monitoring with abstinence reinforcement (mHealth reinforcement) or (2) without reinforcement (mHealth monitoring). Usual care was 8 weeks of transdermal nicotine and twice-weekly telephone counseling. Following training, an interactive voice response system prompted participants to conduct CO tests 1-3 daily at pseudorandom times (7 am to 10 pm) for 4 weeks. When prompted, participants used a study cell phone and CO monitor to complete a CO self-test, video record the process, and submit videos using multimedia messaging. mHealth reinforcement participants could earn prizes for smoking-negative on-time CO tests. The interactive voice response generated preliminary earnings immediately. Earnings were finalized by comparing video records against participants' self-reports. Results mHealth reinforcement was associated with a greater proportion of smoking-negative CO tests, longest duration of prolonged abstinence, and point-prevalence abstinence during the monitoring/reinforcement phase compared to mHealth monitoring (p < .01, d = 0.8-1.3). Follow-up (weeks 4-24) analyses indicated main effects of reinforcement on point-prevalence abstinence and proportion of days smoked (p ≤ .05); values were comparable by week 24. Conclusions mHealth reinforcement has short-term efficacy. Research on methods to enhance and sustain benefits is needed. Implications This study suggests that mHealth abstinence reinforcement is efficacious and may present temporal and spatial opportunities to research, engage, and support smokers trying to quit that do not exist with conventional (not technology-based) reinforcement interventions.
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Affiliation(s)
- Sheila M Alessi
- School of Medicine and Calhoun Cardiology Center - Behavioral Health, University of Connecticut, Farmington, CT
| | - Carla J Rash
- School of Medicine and Calhoun Cardiology Center - Behavioral Health, University of Connecticut, Farmington, CT
| | - Nancy M Petry
- School of Medicine and Calhoun Cardiology Center - Behavioral Health, University of Connecticut, Farmington, CT
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Kaner EFS, Beyer FR, Garnett C, Crane D, Brown J, Muirhead C, Redmore J, O'Donnell A, Newham JJ, de Vocht F, Hickman M, Brown H, Maniatopoulos G, Michie S. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017; 9:CD011479. [PMID: 28944453 PMCID: PMC6483779 DOI: 10.1002/14651858.cd011479.pub2] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Excessive alcohol use contributes significantly to physical and psychological illness, injury and death, and a wide array of social harm in all age groups. A proven strategy for reducing excessive alcohol consumption levels is to offer a brief conversation-based intervention in primary care settings, but more recent technological innovations have enabled people to interact directly via computer, mobile device or smartphone with digital interventions designed to address problem alcohol consumption. OBJECTIVES To assess the effectiveness and cost-effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol-related problems, or both, in people living in the community, specifically: (i) Are digital interventions more effective and cost-effective than no intervention (or minimal input) controls? (ii) Are digital interventions at least equally effective as face-to-face brief alcohol interventions? (iii) What are the effective component behaviour change techniques (BCTs) of such interventions and their mechanisms of action? (iv) What theories or models have been used in the development and/or evaluation of the intervention? Secondary objectives were (i) to assess whether outcomes differ between trials where the digital intervention targets participants attending health, social care, education or other community-based settings and those where it is offered remotely via the internet or mobile phone platforms; (ii) to specify interventions according to their mode of delivery (e.g. functionality features) and assess the impact of mode of delivery on outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, ERIC, HTA and Web of Knowledge databases; ClinicalTrials.com and WHO ICTRP trials registers and relevant websites to April 2017. We also checked the reference lists of included trials and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effectiveness of digital interventions compared with no intervention or with face-to-face interventions for reducing hazardous or harmful alcohol consumption in people living in the community and reported a measure of alcohol consumption. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included 57 studies which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta-analysis, which demonstrated that participants using a digital intervention drank approximately 23 g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate-quality evidence).Fifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate-quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate-quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate-quality evidence).Only five small studies (390 participants) compared digital and face-to-face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI -24.59 to 25.63; low-quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.A median of nine BCTs were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B -43.94, 95% CI -78.59 to -9.30), problem solving (B -48.03, 95% CI -77.79 to -18.27), information about antecedents (B -74.20, 95% CI -117.72 to -30.68), behaviour substitution (B -123.71, 95% CI -184.63 to -62.80) and credible source (B -39.89, 95% CI -72.66 to -7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B -95.12, 95% CI -162.90 to -27.34), problem solving (B -45.92, 95% CI -90.97 to -0.87), and credible source (B -32.09, 95% CI -60.64 to -3.55) were associated with reduced alcohol consumption.The most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness. AUTHORS' CONCLUSIONS There is moderate-quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low-quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face-to-face interventions.The BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.Reporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.
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Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Claire Garnett
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - David Crane
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Jamie Brown
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - James Redmore
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Amy O'Donnell
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - James J Newham
- King's College LondonPrimary Care & Public Health SciencesAddison House, Guy's campusLondonUKSE1 1UL
| | - Frank de Vocht
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Matthew Hickman
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Heather Brown
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Gregory Maniatopoulos
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Susan Michie
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
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Alessi SM, Barnett NP, Petry NM. Experiences with SCRAMx alcohol monitoring technology in 100 alcohol treatment outpatients. Drug Alcohol Depend 2017; 178:417-424. [PMID: 28709081 PMCID: PMC5569301 DOI: 10.1016/j.drugalcdep.2017.05.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/02/2017] [Accepted: 05/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transdermal alcohol monitoring technology allows for new research on alcohol use disorders. This study assessed feasibility, acceptability, and adherence with this technology in the context of two clinical research trials. METHODS Participants were the first 100 community-based alcohol treatment outpatients enrolled in randomized studies that monitored drinking with the secure continuous remote alcohol monitor (SCRAMx®) for 12 weeks. Study 1 participants were randomized to usual care (n=36) or usual care with contingency management incentives for treatment attendance (CM-Att; n=30). Study 2 participants were randomized to usual care (n=17) or usual care with CM for each day of no drinking per SCRAMx (CM-Abst; n=17). After 12 weeks, participants completed a survey about the bracelet. RESULTS Nine percent of individuals screened (54 of 595) declined participation because of the bracelet. Of participants, 84% provided 12weeks of data, and 96% of bracelets were returned fully intact. Ninety-four equipment tampers occurred, affecting 2% of monitoring days; 56% (67) of tampers coincided with detected drinking. Common concerns reported by participants were skin marks (58%), irritation (54%), and interfered with clothing choices (51%), but severity ratings were generally mild (60%-94%). Eighty-one percent of participants reported that the bracelet helped them reduce drinking, and 75% indicated that they would wear it for longer. A common suggestion for improvement was to reduce the size of the bracelet. CONCLUSIONS Results support the viability of transdermal monitoring in voluntary substance abuse treatment participants for an extended duration. Issues to consider for future applications of this technology are discussed.
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Affiliation(s)
- Sheila M Alessi
- University of Connecticut School of Medicine and Calhoun Cardiology Center - Behavioral Health, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
| | - Nancy P Barnett
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, USA.
| | - Nancy M Petry
- University of Connecticut School of Medicine and Calhoun Cardiology Center - Behavioral Health, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
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